|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$268.88
|
| Rate for Payer: Aetna Medicare |
$200.66
|
| Rate for Payer: BCBS Complete |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$200.66
|
| Rate for Payer: BCN Commercial |
$358.33
|
| Rate for Payer: BCN Medicare Advantage |
$200.66
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$288.95
|
| Rate for Payer: Cofinity Commercial |
$268.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.66
|
| Rate for Payer: Healthscope Commercial |
$240.79
|
| Rate for Payer: Healthscope Whirlpool |
$240.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.69
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.73
|
| Rate for Payer: Nomi Health Commercial |
$240.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PACE SWMI |
$200.66
|
| Rate for Payer: PHP Medicare Advantage |
$200.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$322.30
|
| Rate for Payer: Priority Health Medicare |
$200.66
|
| Rate for Payer: Priority Health Narrow Network |
$322.30
|
| Rate for Payer: Railroad Medicare Medicare |
$200.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.66
|
| Rate for Payer: UHC Exchange |
$387.05
|
| Rate for Payer: UHC Medicaid |
$126.31
|
| Rate for Payer: UHCCP DNSP |
$200.66
|
| Rate for Payer: UHCCP Medicaid |
$126.31
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,755.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$398.10 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$803.75
|
| Rate for Payer: Aetna Medicare |
$599.81
|
| Rate for Payer: BCBS Complete |
$418.00
|
| Rate for Payer: BCBS MAPPO |
$599.81
|
| Rate for Payer: BCN Commercial |
$1,031.31
|
| Rate for Payer: BCN Medicare Advantage |
$599.81
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cofinity Commercial |
$863.73
|
| Rate for Payer: Cofinity Commercial |
$803.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.81
|
| Rate for Payer: Healthscope Commercial |
$719.77
|
| Rate for Payer: Healthscope Whirlpool |
$719.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.80
|
| Rate for Payer: Meridian Medicaid |
$418.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$659.79
|
| Rate for Payer: Nomi Health Commercial |
$719.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,316.25
|
| Rate for Payer: PACE SWMI |
$599.81
|
| Rate for Payer: PHP Medicare Advantage |
$599.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,019.05
|
| Rate for Payer: Priority Health Medicare |
$599.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.05
|
| Rate for Payer: Railroad Medicare Medicare |
$599.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,167.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$599.81
|
| Rate for Payer: UHC Exchange |
$1,167.70
|
| Rate for Payer: UHC Medicaid |
$398.10
|
| Rate for Payer: UHCCP DNSP |
$599.81
|
| Rate for Payer: UHCCP Medicaid |
$398.10
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$3,061.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$498.85 |
| Max. Negotiated Rate |
$2,295.75 |
| Rate for Payer: Aetna Commercial |
$1,022.66
|
| Rate for Payer: Aetna Medicare |
$763.18
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$763.18
|
| Rate for Payer: BCN Commercial |
$1,366.96
|
| Rate for Payer: BCN Medicare Advantage |
$763.18
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cofinity Commercial |
$1,098.98
|
| Rate for Payer: Cofinity Commercial |
$1,022.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.18
|
| Rate for Payer: Healthscope Commercial |
$915.82
|
| Rate for Payer: Healthscope Whirlpool |
$915.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.34
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$839.50
|
| Rate for Payer: Nomi Health Commercial |
$915.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,295.75
|
| Rate for Payer: PACE SWMI |
$763.18
|
| Rate for Payer: PHP Medicare Advantage |
$763.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,251.12
|
| Rate for Payer: Priority Health Medicare |
$763.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,251.12
|
| Rate for Payer: Railroad Medicare Medicare |
$763.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,597.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$763.18
|
| Rate for Payer: UHC Exchange |
$1,597.09
|
| Rate for Payer: UHC Medicaid |
$498.85
|
| Rate for Payer: UHCCP DNSP |
$763.18
|
| Rate for Payer: UHCCP Medicaid |
$498.85
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS J7298
|
| Min. Negotiated Rate |
$1,101.70 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,219.54
|
| Rate for Payer: BCN Commercial |
$1,220.70
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,137.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,272.44
|
| Rate for Payer: UHC Exchange |
$1,272.44
|
| Rate for Payer: UHC Medicaid |
$1,287.51
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
|
PR MISC VISION ITEM OR SERVICE
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS V2799
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
|
|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
|
|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Commercial |
$38.14
|
| Rate for Payer: Aetna Medicare |
$28.46
|
| Rate for Payer: BCBS MAPPO |
$28.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.82
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: BCN Medicare Advantage |
$28.46
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$40.98
|
| Rate for Payer: Cofinity Commercial |
$38.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.46
|
| Rate for Payer: Healthscope Commercial |
$34.15
|
| Rate for Payer: Healthscope Whirlpool |
$34.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.31
|
| Rate for Payer: Nomi Health Commercial |
$34.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: PACE SWMI |
$28.46
|
| Rate for Payer: PHP Medicare Advantage |
$28.46
|
| Rate for Payer: Priority Health Medicare |
$28.46
|
| Rate for Payer: Railroad Medicare Medicare |
$28.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.46
|
| Rate for Payer: UHC Exchange |
$26.10
|
| Rate for Payer: UHCCP DNSP |
$28.46
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$442.53 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Aetna Commercial |
$592.99
|
| Rate for Payer: Aetna Commercial |
$592.99
|
| Rate for Payer: Aetna Medicare |
$442.53
|
| Rate for Payer: Aetna Medicare |
$442.53
|
| Rate for Payer: BCBS MAPPO |
$442.53
|
| Rate for Payer: BCBS MAPPO |
$442.53
|
| Rate for Payer: BCN Commercial |
$655.34
|
| Rate for Payer: BCN Commercial |
$655.34
|
| Rate for Payer: BCN Medicare Advantage |
$442.53
|
| Rate for Payer: BCN Medicare Advantage |
$442.53
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$592.99
|
| Rate for Payer: Cofinity Commercial |
$637.24
|
| Rate for Payer: Cofinity Commercial |
$592.99
|
| Rate for Payer: Cofinity Commercial |
$637.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.53
|
| Rate for Payer: Healthscope Commercial |
$531.04
|
| Rate for Payer: Healthscope Commercial |
$531.04
|
| Rate for Payer: Healthscope Whirlpool |
$531.04
|
| Rate for Payer: Healthscope Whirlpool |
$531.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$486.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$486.78
|
| Rate for Payer: Nomi Health Commercial |
$531.04
|
| Rate for Payer: Nomi Health Commercial |
$531.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$768.75
|
| Rate for Payer: PACE SWMI |
$442.53
|
| Rate for Payer: PACE SWMI |
$442.53
|
| Rate for Payer: PHP Medicare Advantage |
$442.53
|
| Rate for Payer: PHP Medicare Advantage |
$442.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$604.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$604.37
|
| Rate for Payer: Priority Health Medicare |
$442.53
|
| Rate for Payer: Priority Health Medicare |
$442.53
|
| Rate for Payer: Priority Health Narrow Network |
$604.37
|
| Rate for Payer: Priority Health Narrow Network |
$604.37
|
| Rate for Payer: Railroad Medicare Medicare |
$442.53
|
| Rate for Payer: Railroad Medicare Medicare |
$442.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$629.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$629.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$442.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$442.53
|
| Rate for Payer: UHC Exchange |
$629.17
|
| Rate for Payer: UHC Exchange |
$629.17
|
| Rate for Payer: UHCCP DNSP |
$442.53
|
| Rate for Payer: UHCCP DNSP |
$442.53
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$711.75 |
| Rate for Payer: Aetna Commercial |
$240.49
|
| Rate for Payer: Aetna Medicare |
$179.47
|
| Rate for Payer: BCBS Complete |
$123.68
|
| Rate for Payer: BCBS MAPPO |
$179.47
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$179.47
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$258.44
|
| Rate for Payer: Cofinity Commercial |
$240.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.47
|
| Rate for Payer: Healthscope Commercial |
$215.36
|
| Rate for Payer: Healthscope Whirlpool |
$215.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.44
|
| Rate for Payer: Meridian Medicaid |
$123.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$197.42
|
| Rate for Payer: Nomi Health Commercial |
$215.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.75
|
| Rate for Payer: PACE SWMI |
$179.47
|
| Rate for Payer: PHP Medicare Advantage |
$179.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$320.47
|
| Rate for Payer: Priority Health Medicare |
$179.47
|
| Rate for Payer: Priority Health Narrow Network |
$320.47
|
| Rate for Payer: Railroad Medicare Medicare |
$179.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$179.47
|
| Rate for Payer: UHC Exchange |
$339.79
|
| Rate for Payer: UHC Medicaid |
$117.79
|
| Rate for Payer: UHCCP DNSP |
$179.47
|
| Rate for Payer: UHCCP Medicaid |
$117.79
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$109.08
|
| Rate for Payer: Aetna Medicare |
$81.40
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$81.40
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$81.40
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$109.08
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.40
|
| Rate for Payer: Healthscope Commercial |
$97.68
|
| Rate for Payer: Healthscope Whirlpool |
$97.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.54
|
| Rate for Payer: Nomi Health Commercial |
$97.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: PACE SWMI |
$81.40
|
| Rate for Payer: PHP Medicare Advantage |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.19
|
| Rate for Payer: Priority Health Medicare |
$81.40
|
| Rate for Payer: Priority Health Narrow Network |
$143.19
|
| Rate for Payer: Railroad Medicare Medicare |
$81.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.40
|
| Rate for Payer: UHC Exchange |
$155.03
|
| Rate for Payer: UHCCP DNSP |
$81.40
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna Commercial |
$143.94
|
| Rate for Payer: Aetna Medicare |
$107.42
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$107.42
|
| Rate for Payer: BCN Commercial |
$178.28
|
| Rate for Payer: BCN Medicare Advantage |
$107.42
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$143.94
|
| Rate for Payer: Cofinity Commercial |
$154.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.42
|
| Rate for Payer: Healthscope Commercial |
$128.90
|
| Rate for Payer: Healthscope Whirlpool |
$128.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.79
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.16
|
| Rate for Payer: Nomi Health Commercial |
$128.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: PACE SWMI |
$107.42
|
| Rate for Payer: PHP Medicare Advantage |
$107.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$217.22
|
| Rate for Payer: Priority Health Medicare |
$107.42
|
| Rate for Payer: Priority Health Narrow Network |
$217.22
|
| Rate for Payer: Railroad Medicare Medicare |
$107.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$107.42
|
| Rate for Payer: UHC Exchange |
$216.68
|
| Rate for Payer: UHC Medicaid |
$68.16
|
| Rate for Payer: UHCCP DNSP |
$107.42
|
| Rate for Payer: UHCCP Medicaid |
$68.16
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.50
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99150
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 99143
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.00
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$106.50 |
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.50
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.75
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$162.49 |
| Rate for Payer: Aetna Commercial |
$72.41
|
| Rate for Payer: Aetna Medicare |
$54.04
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCBS MAPPO |
$54.04
|
| Rate for Payer: BCN Commercial |
$93.55
|
| Rate for Payer: BCN Medicare Advantage |
$54.04
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$77.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.04
|
| Rate for Payer: Healthscope Commercial |
$64.85
|
| Rate for Payer: Healthscope Whirlpool |
$64.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.74
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.44
|
| Rate for Payer: Nomi Health Commercial |
$64.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.75
|
| Rate for Payer: PACE SWMI |
$54.04
|
| Rate for Payer: PHP Medicare Advantage |
$54.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.49
|
| Rate for Payer: Priority Health Medicare |
$54.04
|
| Rate for Payer: Priority Health Narrow Network |
$162.49
|
| Rate for Payer: Railroad Medicare Medicare |
$54.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$54.04
|
| Rate for Payer: UHC Exchange |
$102.85
|
| Rate for Payer: UHC Medicaid |
$34.51
|
| Rate for Payer: UHCCP DNSP |
$54.04
|
| Rate for Payer: UHCCP Medicaid |
$34.51
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$233.76 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna Medicare |
$81.66
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCN Commercial |
$134.57
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$117.59
|
| Rate for Payer: Cofinity Commercial |
$109.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Healthscope Commercial |
$97.99
|
| Rate for Payer: Healthscope Whirlpool |
$97.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.74
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.83
|
| Rate for Payer: Nomi Health Commercial |
$97.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.25
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.76
|
| Rate for Payer: Priority Health Medicare |
$81.66
|
| Rate for Payer: Priority Health Narrow Network |
$233.76
|
| Rate for Payer: Railroad Medicare Medicare |
$81.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.66
|
| Rate for Payer: UHC Exchange |
$139.60
|
| Rate for Payer: UHC Medicaid |
$51.97
|
| Rate for Payer: UHCCP DNSP |
$81.66
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$209.06 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: Aetna Medicare |
$71.12
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS MAPPO |
$71.12
|
| Rate for Payer: BCN Commercial |
$120.35
|
| Rate for Payer: BCN Medicare Advantage |
$71.12
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$95.30
|
| Rate for Payer: Cofinity Commercial |
$102.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.12
|
| Rate for Payer: Healthscope Commercial |
$85.34
|
| Rate for Payer: Healthscope Whirlpool |
$85.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.68
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.23
|
| Rate for Payer: Nomi Health Commercial |
$85.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE SWMI |
$71.12
|
| Rate for Payer: PHP Medicare Advantage |
$71.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$209.06
|
| Rate for Payer: Priority Health Medicare |
$71.12
|
| Rate for Payer: Priority Health Narrow Network |
$209.06
|
| Rate for Payer: Railroad Medicare Medicare |
$71.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.12
|
| Rate for Payer: UHC Exchange |
$126.92
|
| Rate for Payer: UHC Medicaid |
$45.37
|
| Rate for Payer: UHCCP DNSP |
$71.12
|
| Rate for Payer: UHCCP Medicaid |
$45.37
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$11.43
|
| Rate for Payer: BCN Commercial |
$19.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.43
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$13.72
|
| Rate for Payer: Healthscope Whirlpool |
$13.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.57
|
| Rate for Payer: Nomi Health Commercial |
$13.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE SWMI |
$11.43
|
| Rate for Payer: PHP Medicare Advantage |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.20
|
| Rate for Payer: Priority Health Medicare |
$11.43
|
| Rate for Payer: Priority Health Narrow Network |
$19.20
|
| Rate for Payer: Railroad Medicare Medicare |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.43
|
| Rate for Payer: UHC Exchange |
$16.00
|
| Rate for Payer: UHCCP DNSP |
$11.43
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: Aetna Medicare |
$20.88
|
| Rate for Payer: BCBS Complete |
$14.09
|
| Rate for Payer: BCBS MAPPO |
$20.88
|
| Rate for Payer: BCN Commercial |
$38.84
|
| Rate for Payer: BCN Medicare Advantage |
$20.88
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$30.07
|
| Rate for Payer: Cofinity Commercial |
$27.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Whirlpool |
$25.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.92
|
| Rate for Payer: Meridian Medicaid |
$14.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.97
|
| Rate for Payer: Nomi Health Commercial |
$25.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$20.88
|
| Rate for Payer: PHP Medicare Advantage |
$20.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.48
|
| Rate for Payer: Priority Health Medicare |
$20.88
|
| Rate for Payer: Priority Health Narrow Network |
$67.48
|
| Rate for Payer: Railroad Medicare Medicare |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.88
|
| Rate for Payer: UHC Exchange |
$38.33
|
| Rate for Payer: UHC Medicaid |
$13.42
|
| Rate for Payer: UHCCP DNSP |
$20.88
|
| Rate for Payer: UHCCP Medicaid |
$13.42
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$14.75
|
| Rate for Payer: Aetna Medicare |
$11.01
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$11.01
|
| Rate for Payer: BCN Commercial |
$19.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.01
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$14.75
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.01
|
| Rate for Payer: Healthscope Commercial |
$13.21
|
| Rate for Payer: Healthscope Whirlpool |
$13.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.56
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.11
|
| Rate for Payer: Nomi Health Commercial |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE SWMI |
$11.01
|
| Rate for Payer: PHP Medicare Advantage |
$11.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.51
|
| Rate for Payer: Priority Health Medicare |
$11.01
|
| Rate for Payer: Priority Health Narrow Network |
$39.51
|
| Rate for Payer: Railroad Medicare Medicare |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.01
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$7.03
|
| Rate for Payer: UHCCP DNSP |
$11.01
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
|
|
PR MONALISA TOUCH, SERIES, UP TO 7 VISITS, LICHEN SCLEROSUS
|
Professional
|
Both
|
$2,206.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,654.50 |
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,654.50
|
|
|
PR MONOVISC INJ PER DOSE
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS J7327
|
| Min. Negotiated Rate |
$564.77 |
| Max. Negotiated Rate |
$943.69 |
| Rate for Payer: Aetna Commercial |
$878.16
|
| Rate for Payer: Aetna Medicare |
$655.34
|
| Rate for Payer: BCBS MAPPO |
$655.34
|
| Rate for Payer: BCBS Trust/PPO |
$575.42
|
| Rate for Payer: BCN Commercial |
$800.00
|
| Rate for Payer: BCN Medicare Advantage |
$655.34
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$943.69
|
| Rate for Payer: Cofinity Commercial |
$878.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.34
|
| Rate for Payer: Healthscope Commercial |
$786.41
|
| Rate for Payer: Healthscope Whirlpool |
$786.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$720.87
|
| Rate for Payer: Nomi Health Commercial |
$786.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.75
|
| Rate for Payer: PACE SWMI |
$655.34
|
| Rate for Payer: PHP Medicare Advantage |
$655.34
|
| Rate for Payer: Priority Health Medicare |
$655.34
|
| Rate for Payer: Railroad Medicare Medicare |
$655.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$564.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.34
|
| Rate for Payer: UHC Exchange |
$564.77
|
| Rate for Payer: UHCCP DNSP |
$655.34
|
|
|
PR MORPHINE SULFATE INJECTION
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.45
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$5.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.34
|
| Rate for Payer: Healthscope Whirlpool |
$5.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$5.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.00
|
| Rate for Payer: PACE SWMI |
$4.45
|
| Rate for Payer: PHP Medicare Advantage |
$4.45
|
| Rate for Payer: Priority Health Medicare |
$4.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.45
|
| Rate for Payer: UHC Exchange |
$3.04
|
| Rate for Payer: UHCCP DNSP |
$4.45
|
|
